1. Field of the Invention
This invention relates to surgical instruments for use in heart bypass surgery and more particularly relates to an adjustable heart surface stabilizer to stabilize a surgical site on heart surface tissue against the motion of the beating heart.
2. Background Information
Heart bypass surgery known as coronary artery bypass graft (CABG) procedure has become a widely used effective treatment for a heart ailment known as arteriosclerosis. This disease is a restriction "clogging" of blood to the heart muscle. This condition is treated by performing a coronary artery bypass graft procedure to bypass the clogged arteries. In some cases when there are blockages to several arteries double, triple, and quadruple bypass grafts have to be made. The grafts bypass the obstructed or occluded portion restoring normal life giving blood flow to the heart muscle. The graft is usually obtained from an artery or vein in another part of the body.
When surgeons initially began using this surgical technique heart bypass machines were used and the heart was temporarily stopped. This resulted in long surgical procedures necessary to hook the patient up to a heart bypass machine so their blood was circulated and oxygenated while surgery was being performed on the heart. This made the surgery long increasing the trauma to the patient and made the procedure risky to the patient's health.
When the grafts were completed the patient had to be removed from the heart bypass machine and the heart re-started. The risk to the patient to stop, bypass and re-start the heart was very great. Efforts have been made to improve the treatment to reduce the trauma to the patient. These efforts are directed to procedures that are less invasive and less traumatic but are techniques that still require the use of heart bypass (cardiopulmonary bypass) machines and stopping the heart (cardioplagia). The risk to the patient could be greatly reduced if the need to stop the heart could be avoided. Without the need to stop the heart the intensive surgical procedure of connecting the patient to a cardiopulmonary bypass machine would be eliminated.
New procedures have been developed to perform the heart bypass surgery without stopping the heart. In these procedures the heart is still beating while the surgery is being performed to attach a graft to the effected area. The surgery can be performed without the necessity to make a large incision down the center of the chest and cut through the entire sternum in order to connect the patient to a heart bypass machine. The surgery is thus much less invasive and can be performed through the smaller incisions between the ribs. A graft is sewn in to bypass an obstruction while the heart is still beating.
The grafting procedure known as "anastomosis" restores blood flow with a vein or arterial graft that "bypasses" a clogged or obstructed artery such as the left anterior descending artery or other vessel. Typically a bypass is grafted to a blood source that is unobstructed to bypass the occlude artery obstruction restoring blood flow to the heart muscle. In some cases several grafts are required to bypass two, three or more obstructions. This procedure is difficult with the heart beating. Ends of the graft must be carefully sewn to the arteries on either sides of the obstruction with delicate small sutures to firmly attach the graft to prevent any leaks.
Methods have been devised to stabilize the outer layer of the heart surface tissue with limited success. One method is to place sutures on opposite sides of the surgical site in the outer layer where the surgery is to be performed and stretch the tissue to minimize movement. The tissue is stretched tightly to minimize movement while the heart muscle continues to beat. This procedure presents some risk of temporary damage to the outer tissue involved. Also this procedure takes additional time and is less than ideal.
Another alternative is to use a suction device to stabilize the outer surface tissue of the heart where the surgery is to be performed. A suction device with several ports is attached to the heart outer surface tissue to reduce motion of the outer layer. This method while effective can cause bruising and temporary small hematomas at the site of e suction parts. There is a need for a surgical instrument that can effectively reduce motion and stabilize a localize small area of heart surface tissue where an anastomosis is to be performed. An instrument that can be quickly and easily installed would allow an anastomosis to be performed more effectively, more easily, more quickly, more safely with much less trauma to the patient.
A device for stabilizing an area of surface tissue of the heart is described in European Patent Application Number 97102789.1 published on Aug. 27, 1997. In this application numerous configuration and variation of planar members attached to shafts are described. A plethora of complicated shafts and mechanisms for mounting and manipulating the contrast members are shown as well as numerous design for the contact members.
It is one object of the present invention to provide a surgical instrument that can stabilize a localized surgical site on surface tissue of the heart for performing an anastomosis.
Another object of the present invention is to provide a surgical instrument comprised of a rectangular flat frame having sections that press against a heart surface tissue at a surgical site and minimize motion.
Yet another object of the present invention is to provide a flat stabilizing plate having gripping surfaces to firmly stabilize and cushion a surgical site and a heart surface tissue against heart beat motion.
Still another object of the present invention is to provide a simple, easy way manipulate a flat rectangular stabilizer that is adjustable to angles and conform to the shape of the heart.
Yet another object of the present invention is to provide a rectangular flat plate heart surface stabilizer that is simple in construction and easy to use.
Still another object of the invention is to provide a heart stabilizer attached to a rigid shaft that can be quickly and easily attached to a retractor.
Yet another object of the present invention is to provide a rectangular flat plate stabilizer having an adjustable locking connection to a rigid shaft for adjusting the angle of the stabilizer.
Still another object of the present invention is to provide a heart surface area stabilizer that can apply pressure to a blood vessel to reduce the flow of blood at the surgical site.
Another object of the present invention is to provide a rectangular flat plate stabilizer for occluding the flow of blood in a vessel during an anastomosis.
Still another object of the invention is to provide a rectangular flat plate stabilizer having a hinged side for removing the stabilizer after completion of an anastomosis.
Another object of the present invention is to provide a flat plate heart surface stabilizer adjustably connected to a rigid shaft having clamps means in said shaft for locking the position of the stabilizer after positioning and adjustment.
Still another object of the present invention is to provide a surgical instrument of a rectangular flat frame for stabilized surface tissue on the heart during heart surgery including an arrangement for adjusting the angle of the flat rectangular plate from outside the incision.
Yet another object of the present invention is to provide a heart surface tissue stabilizing device that is adjustable by means of a wobble plate mounted on the outer end of a shaft for making adjustments from outside the incision.
Still another object of the present invention is to provide a heart surface tissue stabilizing device of an adjustable flat rectangular plate having a gimbal or yoke arrangement for adjusting the position of the plate against the heart surface tissue from outside the incision.